The U.S. Preventive Services Task Force (USPSTF), an independent panel of experts in prevention and evidence-based medicine from outside the federal government, recently published new guidelines for cervical cancer screening. Three health organizations—the American Cancer Society, the American Society for Clinical Pathology, and the American Society for Colposcopy and Cervical Pathology—also have released new cervical cancer screening guidelines.
Although the USPSTF and the three health organizations developed their guidelines independently, their recommendations are consistent with one another. The USPSTF recommends screening with cytology (Pap test) for women aged 21 to 65 every three years. Women aged 30 to 65 can safely extend the screening interval to once every five years if they undergo concurrent human papillomavirus (HPV) testing with the Pap test. Screening is not recommended for women younger than 21 years, women older than 65 years who have had adequate prior screening and are not otherwise at high risk of cervical cancer, or women who have had a hysterectomy with removal of the cervix and do not have a history of high-grade precancerous lesions (i.e., grade 2 or 3 cervical intraepithelial neoplasia) or cervical cancer. Furthermore, the USPSTF recommends against screening for cervical cancer with HPV testing, alone or in combination with cytology, in women younger than 30 years.
Revisions of the guidelines were informed by results from POBASCAM (Population-Based Screening Study Amsterdam), a randomized controlled trial for implementation of high-risk HPV testing in cervical cancer screening, and a population-based study in routine clinical practice conducted by Hormuzd A. Katki, Ph.D., Biostatistics Branch, and colleagues, which included nearly 332,000 women who underwent both HPV and Pap testing at Kaiser Permanente Northern California. Details of Dr. Katki’s study, titled “Cervical cancer risk for women undergoing concurrent testing for human papillomavirus and cervical cytology: A population-based study in routine clinical practice,” were published in Lancet Oncology, and a summary of the results is available in the March 2012 issue of Linkage.